Personal blog of Dr Alex Mendelsohn

Category: Personal

On the big questions

I received an email from a very nice person seeking advice and help about their future career choice. I replied saying that I don’t usually give advice because of how complex individuals can be. One piece of advice that might work for one person, may be detrimental to another. However, what I did do was speak from my own experiences – hoping that themes within them apply to their personal situation. I noted that what I wrote could be complete rubbish!

The email correspondence between us helped me to get some of my thoughts down on paper. And, I would like to put them up on my blog just in case someone else finds value in my experiences. This is the fourth of five blog posts.

This blog post discusses Alex’s personal experiences with anxiety and how it affected their perception of the “big questions” in life. They came to the realisation that framing decision-making based on their mood state rather than logical frameworks made more sense for them. They also believe that answering small questions can lead to a better understanding of the bigger picture. Alex suggests that the big question of “what is free will?” may not be the correct question to ask based on their experience with mental illness.

When I became severely anxious overnight, suddenly, some of the big questions became extremely important. But funnily enough, they all seemed to revolve around death and dying. After my severe reaction, I have given no thought at all as to whether free will exists or the hallmark of a life well lived.

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Nearly a year on, Bupropion is still not available

Update: GSK announced UK and EU resupply of Zyban (bupropion) for December 2023, see this blog post for more details

This blog post discusses the continued shortage of the antidepressant and smoking cessation medication Bupropion, also known as Zyban, due to nitrosamine impurities. Alex notes that GSK has not yet issued a recall order for Zyban, despite doing so for other medications with similar impurities, and that the brand name has been discontinued in the US. The FDA has determined that the US withdrawal was not due to safety reasons, and GSK has not given an estimated recovery date. The UK government is aware of the supply shortage, and the Medicines and Healthcare products Regulatory Agency is blocking imports into the UK. Alex expresses concern about the possibility of GSK withdrawing the product altogether, and the lack of transparency in the industry.

It has been just over eight months since GSK announced they were halting the supply of Bupropion (the brand name is “Zyban”) due to nitrosamine impurities. Since my previous blog post about the supply shortage, I have heard very little.

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The pharmaceutical industry just stopped producing the only antidepressant that has worked for me

The blog post discusses the recent stoppage of the production of Bupropion (Zyban) and Varenicline (Champix) due to the detection of impurities that could increase the risk of cancer. Alex, who suffers from chronic depression, argues that the benefits of the antidepressant outweigh the minimal risk of cancer. Alex also criticizes the lack of availability of alternative treatments for depression and smoking cessation, particularly MAOIs and the lack of supply of smoking cessation drugs in the UK. Alex questions the logic of discontinuing acute treatments for smoking cessation due to a small risk of cancer over a few months.

Imagine the scenario. Potential impurities are found in some HIV retroviral drugs that produce a small increase in the probability of contracting cancer over their lifetime. I think the last thing you would expect would be the immediate stoppage of the production of the antiretroviral drugs in question. Leaving a patient vulnerable to imminent death as HIV progresses to AIDS is of greater importance than a tiny increase in lifetime cancer risk.

Yet, in the world of mental health treatment, this type of scenario has recently unfolded with the stoppage of the supply of Bupropion (Zyban) in the UK, leaving me and many others without the drug keeping them out of depression.

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Why I am using a pen name (for now)

Alex has had negative experiences with clinicians in the past and has struggled to find a psychiatrist they trust. After finding a psychiatrist and a combination of medications that have helped ease their symptoms, they plan to share their experiences through various platforms. However, they wish to remain anonymous for now as they criticize aspects of psychiatry, psychotherapy, and neuroscience and do not want their current psychiatrist to discontinue their service. Once their symptoms have improved and they feel safe enough, they plan to reveal their true identity while keeping the pen name Alex Mendelsohn. They hope to use their unique perspective to help others and prevent similar negative experiences from happening to others.

In the past, I have been refused treatments that eventually worked, and had interactions with past clinicians that unintentionally drove me towards suicide, rather than away from it.

It took me a very long time to find a psychiatrist I trust. Once I did, we landed on a combination of medications that have progressively eased my symptoms over the last couple of years. I take one of these medications off-label (this means that the medication is licensed for another condition, not the one I am taking it for). My current psychiatrist is the first I have met willing to prescribe this medication.

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The secrets to anxiety are inside my head – all someone needs to do is look

This is quite possibly going to be the most self-aggrandising article I will ever write. Maybe I have finally descended into pure and utter delusion. But the experimentalist in me strongly believes that what I say in the title is true. I think my life accidentally became the near perfect experiment to discover biochemical causes of anxiety.

Alex shares his personal experience with anxiety, which they believe was initiated by taking the antidepressant Sertraline. He discovered several case studies that also describe the development of anxiety symptoms in patients shortly after taking Sertraline. However, Alex’s anxiety symptoms persisted and worsened after cessation of the medication, unlike the patients in the case studies. Alex believes that their experience could be a special case that could help uncover the biochemical causes of anxiety disorders. Alex advocates for a more complex approach to understanding the causes of anxiety disorders that takes into account both nature and nurture.

“How did I miss this?” I say to myself. I had just found a case study by Catalano et al. [1] describing the development of panic attacks in two patients shortly after initiation of the antidepressant Sertraline. Importantly, the patients had no personal or family history of any anxiety condition. I had been searching for an article like this since 2015. It was now 2021.

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The story of how my Physics World article came to be

Referring to the article: A physicist’s experience of the mental-health system

and podcast: Start-up simulates quantum photonics devices, a physicist’s experience of the mental-health system

Alex wrote a manuscript about their experiences with mental illness that they shared with a psychiatric researcher, but received no response. Undeterred, they cold-emailed psychiatric researchers and scientific magazines but only received rejections. Eventually, the editor of Physics World magazine reached out and expressed interest in publishing the manuscript. Despite being surprised and skeptical at first, Alex’s article was eventually published after six months. Alex thanks the editor for being courageous enough to publish something not typically seen in a physics magazine and wonders if there are more people out there willing to act and care about mental health issues.

A while ago, my counsellor asked me to write something to give to a psychiatric researcher she knew from her work at a mental health hospital. She felt strongly that the things I was talking about in our sessions needed to be heard.

I obliged. I wrote a sort of manuscript looking thing. At that time I didn’t have the energy to write it in any sort of structure to help the reader. All I could do was splurge what was in my head onto paper. I cleaned it up as much as I could, then sent it off to her.

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Hope is found in a corridor of darkness, feet and hands chained to the ground, only the faintest speck of light far off in the distance.

It is not found at the start of a race or in the bleachers of a stadium.
It is not found in political offices, on posters or a ballot paper.
It is not found in forward-thinking companies, in school halls or lecture theatres.

It is not the search to find a friend or lover.
It is not in a lottery ticket or job position.
It is not following a pop star, motivational speaker or politician.

It is not a yearning or an ambition or a heroic figure.

Hope, is keeping your head turned towards the light, even after it seems to fade from view.